Is there an optimal day within the first 14 days to initiate anticoagulation with a direct oral anticoagulant after atrial fibrillation–associated acute ischemic stroke?
Findings In this phase 2, response-adaptive randomized clinical trial, none of the 4 groups met statistical criteria as the optimal day for treatment initiation. Group 1 (initiation of a direct oral anticoagulant 3-4 days after atrial fibrillation–associated ischemic stroke for secondary stroke prevention) had no ischemic events and the highest posterior probability (0.41) of being optimal for
treatment initiation.
Although a clearly superior day to initiate use of a direct oral anticoagulant was not identified, the evidence suggests that initiating a direct oral anticoagulant earlier is better than later within the first 2 weeks after stroke due to atrial fibrillation.
